It really is the Sickness Industry.

Harming not healing

America | The identity of a second whistleblower at the Texas Children’s Hospital—home to a controversial gender medicine program—has been revealed. Vanessa Sivadge, a nurse, came to believe that the underlying problems of minors—such as depression, addiction and discomfort with puberty—were being ignored in favour of gender medicalisation. She told journalist Christopher Rufo: “In the cardiac clinic, we were taking sick kids and making them better. In the transgender clinic, it was the opposite. We were harming these kids.” Last year, Sivadge said, FBI agents came to her home and told her she was a “person of interest” in their investigation of the whistleblower later identified as surgeon Eithan Haim. At the hospital, Sivadge said she had noticed discrepancies in paperwork suggesting that gender medicine was being billed to the government-funded Texas Medicaid program, which was not supposed to cover such procedures. Texas Attorney-General Ken Paxton has announced an investigation into possible Medicaid fraud. Meanwhile, indictments against Dr Haim, brought by the Biden Administration’s Department of Justice, have been unsealed. They accuse the surgeon of unlawfully obtaining patient information. Dr Haim has said that only de-identified information was passed to Mr Rufo in order to confirm that, contrary to its public statements, the hospital was continuing to practise gender medicine. Dr Haim faces penalties up to 10 years in prison.

The case against Dr Haim has been condemned in various quarters. In a letter to US Attorney-General Merrick Garland and FBI Director Christopher Wray, Republican Senator Josh Hawley said the prosecution was “an unconscionable abuse of legal process, in service of shoddy and irresponsible gender ideology.” In the magazine National Review, lawyer Ed Whelan, who holds the Antonin Scalia Chair in Constitutional Studies at the Ethics and Public Policy Center, wrote: “If a whistleblower did what Dr Haim is alleged to have done to expose, say, that a hospital had committed racial discrimination or Medicaid fraud, it is unfathomable that [the Department of Justice] would threaten the whistleblower with a life-destroying criminal prosecution. The only reason that Dr Haim is being targeted is that he has run afoul of the transgender ideology that dominates the Biden Administration. Without any supporting allegations, the indictment contends that Dr Haim acted with ‘malicious intent’ and sought ‘to cause malicious harm’ to the hospital’s physicians and patients. I am not aware of an iota of evidence that would suggest that Dr Haim acted with malice. In his own words, ‘I knew that it was my moral responsibility to expose what was happening to these children’.”

This should be global - wait till adults is a must Just too young

New Zealand | New Zealand’s acting prime minister, Winston Peters, has cast doubt on the capacity of minors to consent to medicalised gender change. Asked about the issue in the context of England’s Cass review, Mr Peters expressed concern about young people mistakenly making irreversible decisions. “And they’ll be living their life with that mistake, because adults didn’t have enough courage or common sense to ask them to wait until they could make a decision at an age of maturity,” he said earlier this month in an interview with Bob McCoskrie, founder of the Christian watchdog group Family First NZ. Mr Peters said: “Young people unable to make up their mind are being destroyed for life, by what I might call loose, liberal views of their entitlement to make decisions at an early time when their minds are not [fully developed]. Go and ask any criminal lawyer—and the first thing they say when somebody is under a certain age is that this person is not fully mature yet.” Mr Peters’ New Zealand First New Zealand party is a member of the country’s governing centre-right coalition.

New Zealand awaits the long-delayed results of an “evidence brief” on puberty blockers from the Ministry of Health. In 2022, the ministry quietly abandoned its public website claim that blockers were “safe and fully reversible.” That change recognised the shift to caution on gender medicine in Europe. The latest delay in publishing the verdict of the NZ evidence brief on blockers has been attributed to April’s Cass report.

entail longer use of interventions to suppress puberty or earlier commencement of masculinising/feminising hormones, remains unknown as early studies of outcomes of interventions to suppress puberty mandated a minimum age of 12,” the York researchers said.

And while puberty blockers remain routine treatment in Australian gender clinics, they have been confined to clinical trials in England in line with the Cass report’s concern about the lack of safety data and uncertainty surrounding their very rationale.

In April 2022, Dr Telfer—with gender clinic research lead Dr Ken Pang and trans activist Jeremy Wiggins—had argued that Dr Cass’s interim report should have given the green light for routine treatment with puberty blockers to continue, notwithstanding a finding that the evidence was of “very low certainty”.

In the British Medical Journal, the three Australian authors said gender clinics giving children puberty blocker drugs and cross-sex hormones could not wait for long-term data on the safety of these interventions.

“It will take many years to obtain these [undoubtedly needed] long-term data,” the article said.

The Australians argued there was enough existing evidence and international agreement among gender-affirming clinicians to continue these medical treatments aimed at stopping unwanted puberty, then mimicking opposite-sex development.

According to the final Cass report, however, the “apparent consensus” in favour of the gender-affirming model is an artefact of a circular pattern of referencing among various low-quality treatment guidelines, the RCH document included.

GCN sought comment from Mr Butler, RCH Melbourne and Dr Telfer. GCN does not dispute that gender-affirming clinicians believe their interventions benefit vulnerable young people

1

The advice to the minister does not mention the post-2019 independent systematic reviews of the evidence base in Finland, Sweden and the UK, including two reviews by the National Institute for Health and Care Excellence undertaken as part of the Cass review.
2

Mr Butler’s meeting with LGBTIQ+ Health Australia—which sits on a healthcare advisory group chaired by Assistant Health Minister Ged Kearney—followed a June 2023 Senate estimates hearing in which his departmental secretary, Professor Brendan Murphy, was asked questions about puberty blocker usage and oversight. These hormone suppression drugs are used off-label with gender dysphoria. They are approved for other conditions such as prostate cancer and precocious (or premature) puberty.
3

The Queensland Children’s Hospital gender clinic told the Cass review that it did not screen new patients for autism because such screening was “not accurate in [the] trans population.”
4

GCN alerted Healthdirect to errors in April. Family law does not set a minimum age for any kind of trans surgery, as long as parents and doctors aren’t in disagreement. It’s not uncommon for activists to claim that no surgery takes place under the age of 18. In Australia, girls as young as 15 have been referred for trans mastectomies.
5

It’s not explained how multi-disciplinary assessment overcomes a weak and uncertain evidence base.
6

A 10-year audit of the RCH gender clinic reported that 29 per cent of patients aged 10 or older received puberty blockers, while 38 per cent of those minors aged 16-17 received cross-sex hormones. However, the period covered (2007-16) is unlikely to be representative. It mostly predates the boom years of the clinic. From 2007-2013, there were less than 100 new referrals. In 2013, the Family Court liberalised access to blockers, and the judges did the same for hormones in 2017. In 2015, the clinic was given $6 million in extra funding, partly to pay for puberty blockers. From 2014-2022, there were 3,284 new referrals at the clinic.

ding to a departmental brief sent to Minister Butler in May 2023.

The latest brief to the minister from April this year may also be significant for what it does not say. It notes that in advice given to former Health Minister Greg Hunt in 2020, the Royal Australasian College of Physicians (RACP) “expressed support for the principles underlying these [RCH] guidelines and their emphasis of a holistic, multi-disciplinary person-centred care approach”.

Unlike previous briefs to Mr Butler, this latest departmental advice does not highlight the RACP’s unsupported claim that a national inquiry into gender clinics “would further harm vulnerable patients and their families.”

No data, sorry

In a June 2023 Senate estimates hearing, the then secretary of the department, Brendan Murphy, was asked by National Party Senator Matt Canavan about the “remarkable” growth in patient numbers at the RCH Melbourne gender clinic. The context was the inability of federal officials to supply any data on puberty blocker use.

Professor Murphy said he shared “concerns about the capacity of children to make decisions in this matter.”

“But we have sought assurances from [RCH] that they have a very robust process where there are psychiatrists and psychologists and social workers. Their assessments go over many months. I’m assured that the board and the governance of the children’s hospital and the Victorian Health Department continue to review that program,” he said.

In August the year before, Professor Murphy had received an email from RCH chief executive Bernadette McDonald, forwarding to him what she thought might be a “helpful” document written by the then gender clinic director, Dr Telfer.

This document, obtained recently under freedom of information law, ran to a little more than two pages and was titled, “Examination of the Cass review and considerations of implications for the RCH Gender Service.”

The interim report of the Cass review had been published in February 2022 and the London-based Tavistock gender clinic had been marked for closure following concerns about the influence of an ideological gender-affirming model, rushed administration of puberty blockers, possible confusion of same-sex attraction and trans identity, and clinical neglect of non-gender conditions such as autism.

In her analysis sent to Professor Murphy, Dr Telfer said—

“Predictably, the conservative press and anti-trans groups have celebrated the recommendation of closure of the Tavistock. This has been widely reported on internationally. It has also led to a rise in anti-trans activity via social media and other communication forums, directed at trans people themselves, their families and clinicians who provide care for them. The reporting by these media outlets does not reflect the reality of Dr Cass’s report and is extremely harmful to the trans community.”

She claimed her Melbourne gender clinic “already meets the criteria that Dr Cass has recommended to be implemented in England.”

“The RCH Gender Service, with a well-established, multidisciplinary, integrated and collaborative clinical service with community, educational and research programs embedded across the model, is ideally placed to continue to lead this field internationally.”

Dr Telfer said the Tavistock model was “outdated” because it required all adolescents seeking cross-sex hormones to begin with puberty blockers. The RCH guidelines, with Dr Telfer as first author, did away with minimum ages and advised a start to hormone suppression early in puberty at Tanner stage 2-3.

In her letter sent to Professor Murphy, Dr Telfer included her clinic’s nurse-run intake process in a list of what she claimed were Cass-compliant features.

However, this fast-track towards puberty blockers for very young children—similar fast-tracks are used by paediatric gender clinics in Perth and Brisbane—was criticised for pushing beyond the evidence base by Dr Cass’s final report in April this year and in Cass-commissioned research by the University of York.

“The impact of this [fast-track pathway], which might

ished evidence on the topic [of youth gender dysphoria] prohibited the assessment of level (and quality) of evidence for these recommendations.”

That statement led a pioneer of evidence-based medicine, Professor Gordon Guyatt of Canada’s McMaster University, to declare the RCH guidelines “untrustworthy”.

The Roberts-Goodchild advice to Minister Butler says the RCH guidelines “provide a detailed outline of the roles of each member of the multidisciplinary team, for example, mental health professionals, paediatricians, adolescent physicians or endocrinologists, GPs [general practitioners or primary care doctors], nurses and bioethicists and some allied health professionals.”

However, the advice does not pick up last year’s unannounced change to the guidelines, which now encourage GPs “with sufficient expertise and skill in initiating and monitoring [cross-sex] hormone therapy” to consider starting teenagers on this lifelong treatment without multidisciplinary back up.

It’s not clear in what circumstances a GP could wisely or legally initiate hormones without specialist support. No new research was cited by RCH to justify this relaxation; the most recent studies referenced by the guidelines are from 2018.

“To the extent they have acknowledged [the Cass report] at all, the gender-affirming advocates who run Australia’s public youth gender services have tried to discredit its methods and argued that its recommendations do not apply to Australia. The true intent of these criticisms of Cass [is] revealed in the fact that these advocates also reject calls for a high-quality Australian review. Clearly these critics are more interested in avoiding scrutiny than they are in an honest evaluation of the practice of gender medicine in Australia. The tragedy is that the abandonment of the core medical principle of basing treatment on rigorous assessment and high-quality evidence will ensure that gender-confused children in Australia will continue to be harmed by practices being banned elsewhere.”—psychiatrist Andrew Amos, opinion article, Eureka Street, 14 June 2024

Personal medicine

The RCH guideline insists on a diagnosis of gender dysphoria by an experienced mental health clinician before hormonal treatment⁶.

However, in 2019, the document’s lead author, RCH gender clinic director Michelle Telfer gave evidence to a royal commission into mental health, saying—

“… it’s really interesting when we think about mental health clinicians within the context of trans and gender-diverse children, because you don’t really need someone to diagnose a person with gender dysphoria, because a trans identity is something that’s so innately personal that really only that young person or adult, depending on what time of their life they’re coming in, only they know how they feel about their gender and whether that’s a problem or not for them.

“… what’s really important to note as well, is that it’s not just the mental health clinicians within our team that are there to support mental health, because for trans and gender-diverse children it’s actually the medical interventions as well as some surgical interventions that help their mental health (Emphasis added—GCN).

“So, for young people, they often say, ‘I don’t need to talk about this anymore, I just actually need to transition’, or for someone who might be 12 or 13, ‘My emerging puberty is causing me so much distress’, that the only way to manage that distress and the consequences that come from that distress is actually to have the physical interventions from the paediatricians with puberty blockers.”

Dr Telfer told the commission that “many” of the “post-pubertal trans males [teenage girls]” who arrived as new patients at the clinic in 2018 “were requesting gender-affirming surgical services in the form of chest reconstructive surgery [double mastectomy].”

Low-quality benchmark

In the event of a complaint arising from a child prescribed puberty blockers, the benchmark for deciding any intervention by the Medical Board of Australia would be the RCH guidelines, according

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